APPLICATION FOR ADMISSION TO WW NDT SERVICES WELD SCHOOL 2611 West 5th, Suite B Eugene, OR 97402 PHONE/FAX (541)393-6555, (541)914-9077 WWW.WELDCERTS.COM WW NDT SERVICES WELD SCHOOL prohibits discrimination against its customers, employees, and applicants for employment and student applicants on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the WW NDT SERVICES WELD SCHOOL. First Middle Initial Last Street Address City State Zip Have you ever applied to this school before? Circle One Yes No When? Have you ever attended this school before? Circle One Yes No Did you graduate? If you did not graduate, what was the reason you left? Daytime Phone Number Message Phone Number Cell Phone Number Email Address Date of Birth month/day/year Emergency Contact Information Name Yes No Street Address City, State, Zip Phone Number EDUCATION Secondary Education: High School Graduate – Year ________ GED Year ________ I have completed the following postsecondary education: (Check all that apply) Have not attended college Associate degree Some college Bachelor degree Certificate program at community college Master degree Private career school certificate/diploma Doctorate or professional degree Apprenticeship training Other (Describe below) List the name and location of postsecondary institution(s) you attended: Are you currently employed? (Choose one) Yes, 35+ hours / week Yes, less than 35 hours/week No, not at this time Retired I am pursuing admission for the following reason: (Choose one) Career preparation and employment Advanced training / Continuing education Personal development / Self improvement Applicants must meet the following minimum physical requirements of the welding course with or without “Reasonable Modifications” as outlined in ADA, 42 USC § 12182(b)(2)(A)(ii). Be physically and mentally able to safely Have good eyesight with or without corrective perform essential functions of welding lenses Be able and willing to attend all related Be able to read, hear and understand instructions classroom training as required and warnings Be able to stand for long periods and work in Able to bend, grasp and lift up to 50 pounds confined spaces Application Deadlines: All materials must be submitted by the following dates: Insert applicable schedule for applications to be submitted. Example: APPLICATION FOR ADMISSION MUST BE RECEIVED BY THE SCHOOL NO LATER THAN: Insert the date application must be received by the school FOR CLASSES BEGINNING: Insert Program start date I certify that all statements on this application and accompanying documents are complete and true. I also understand that if I am admitted and do not enroll for the “start date” to which I am admitted, I may need to reapply for admission. I understand that submitted materials will not be returned or duplicated. Signature: _____________________________________________________ Date: _________________________ Is there any other information you would like to provide that might impact your ability to benefit from the program (i.e., physical limitations, dyslexia, attention deficit disorder, etc.)?